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growth of population which began in the 1740$ and only petered out during (he last few years owed little, at any rate in its early stages, to a decline in the mortality rate. Medicine, therefore, can have liad no part in the beginnings of the great demographic
transition.

CHAPTER i$ Madness
The bcnchciat cttt'cts of the iiiedical profession arc now thrown inio doubt, and scientists generally are no longer regarded simply as wise men battling the mysterious forces of nature with supremely

elegant coiiceptual thinking, and incredibly patient and exacting testing and rctesting of data. Newton is now known to have been
PART I

as concerned to establish the measurements of the temple of Solomon or to unravel the meaning of the Book of Revelation as lie was to elucidate the laws of gravity or optics. James Watson's

frank disclosures in The Double Helix of the strength of personal During the last fifteen years, a series of semi-indepenileni intellectual trends have come together to transform the history of what society has thought about madness and how it has treated those it considers mad. Once upon a time, the history of medicine was regarded, like that of pure science, as largely 'internalist,' a story of how a progressive endeavor by a handful of gifted intellectuals slowly replaced superstition and errcft- by empirical proven truth. More recently, however, historians have begun to fit the protagonisis in these ancient intellectual battles more deeply into their social settings. In the process, they have revealed a wcltcr of unproven pseudo-scientific theories, professional or national rivalries, insticuiiunal jealousies, personal and protussional ambitions, cultural conditioning, sexist and racist prejiidicus, political exigencies, economic incentives to save money, and religious biases, out of which new and powerful scientific and medical paradigms have emerged. Some now argue that medic,il progress has been a power grab by the medical profession, and institution.}! treatment tor the purpose of better care has been relabeled the 'great cQnfinement.' It is now credibly believed that hospitals were lethal death traps before Pasteur demonstrated the importance of a sterile envirunment. It is now also generally recognized that doctors may presumably unwittingly - have killed more patients than they cured, certainly before the early nineteenth century, and maybe
before the invention of antibiotics in the mid-twentieth, and that

ambition as a compelling motive behind scientific research has forever destroyed the image of the detached scholar selflessly dedicated to the pursuit of truth. Tlie self-evident fact that exploitation by politicians of (he recent discoveries of nuclear physicists is quite likely to result some time in the next few decades in the destruction ot civilization, and possibly of most life on earth, merely reinforces this atmosphere of cynicisni and suspicion. The second trend has been a turning away from the history of elites, whether intellectual or political, to the history of the poor and downirodden, a trend in which the nature of surviving documenucion has in<;vi.tably also led po a focusing on social 'deviancs,'
such as homosexuals, criminals, and the insane. One effect of this

more catholic approach has been,'in the case of the history of medicine, no longer to limit it to the study of orthodox medicine (as practiced, in England, by the members of the Society of Apothccaries and the Colleges of Physicians and of Surgeons) bui to iiicluLlc also popular medicine, which antcdates Galen and continues to tliis day to be far more widely usutl than orthodoxy likes to admil. Sume otits practitioners were wise women, white witches, whose full significance has only emerged as a byproduct of yet another contemporary trend, a sudden revival of interest in the irrational in general and witchcraft in particular. Today the distinction between magic and science is no longer as clear-cut as it used to be, now that seventeenth-century science is seen as

their most valuable contribution to public welfare was psychological reassurance that help was on its way. The most ambitious attempt ever made to examine the

demography of early modern England concludes that the prolonged

FOUCAULT 46 CRITICAL THOUGHT SERIES

47

emerging from a strange brew compouncic$l of Hermcticism, alchemy, and astrology. Finally, interest in problems associated with madness and its treatment have been stimulated by the writings ofMichel Foucault.-'

society under management by professionally trained doctors? If this is so, was it merely the result of a conspiracy of professionals

to seize power for themselves to lock people up and determine

their treatment? That there was a trend toward confinement is

According to him, the whole post-Enlightcnment attempt to trcnt

the mad more humancly, and to devise positive ways to cure them, was largely an aspect of a drive to confine and isolate all devi.ints

undeniable, but the motivntion is questionable. The mad were put

in society, to lock them up and throw away the key. It was part of what he calls 'the great confinement,' other parts beins the extensive growth of workhouses, schools, and prisons. In the eighteenth century, he says, the mad replaced the medieval lepcrs in
isolation hospitals on the outskirts of cities. There is, he claims, an places of isolation were the same.

into institutions at least partly in order to save them from exposure to great cruelties at the hands of the public or their families. In any case, the few dangerously mnci had been locked up in cages like animals from at least the late Middle Ages. Far from being isolated,
the twenty-odd mnnacled mndmen gibbering and rattling their chains in their filthy cn^cs in Bedlam were one of the great tourist attractions of London from the early sixteenth century to the early nineteenth. It was one of the standard sights of the city, on a par

identical attitude of mind behind the treatment of the two, and the

with the royal tombs nt Westminster Abbey, the lions prowling in

the moat in the Tower of London, the flogging of half-naked whores at Bridewcll, and the bull- and bear-baiting over the river
at Southwark.

devising ways to reform criminals nr cure madmen through incarceration have proved a gigantic failure. Today no one really knows

Poucault is certainly correct that Enlightenment hopes of

what to do with either, except to lock up the former and drug the

latter. Yet the residual belief remains that a test of the moral worth

of a society is the way it treats its more impotent members, the indigent, the sick, and the mad. The battle has thus been**joined between post-Enlightenment optimism about the power of society to provide remedies for human pain and suffering, and a cynical and in America with President Johnson's 'Great Society.' Today,
in 1982, there has rc-emerged the older, more pessimistic view thnt

suspicion that any change is liable to be for the worse. The former effort reached its apogee in the mid-twentieth-century welfare state,
nothing much can or should be done, and that whatever is done is

It has also been pointed out that there were enormous differences in the degree and orpanizntion of incarceration from country to country, England leading the way in private madhouses in the eighteenth century, and France in huge state-supported institutions. Moreover, the chronology is complicated, since the poor were the first to be incarcerated in large numbers in the seventeenth and eighteenth centuries, but the mad only in the nineteenth. In England in 1810, the total number of mad persons in confinement was only 2,500 out of a population of 9 million, or about 30 per 100,000, and the numbers did not begin to rise rapidly until the
i8}os.

donors. So far as the mad are concerned, we are just about where we were five hundred years ago, when, in about 1450, a Lord
Mayor of London concluded that 'some be restored unto their wit

morally corrupting to the recipients and financially crippling to the

Foucault's comparison of treatment of the mad during the early modern period and that of lcpers during the Middle Ages does not
stand up to close examination. Early modern madhouses were not

disused leprosaria but evolved out of medieval hospitals, based on

Arab models. Bethlem Hospital, or Bedlam, is one example. Lepers

and health again. And some be abiding therein for ever, for they
be fallen so much out of themselves that it is incurable unto men.'11

were condemned to lifelong isolation from the community, whereas

very large numbers of the mad have al\vays quickly come and gone.

What is not by any means so certain, however, is whether there is

During the year 1788, for example, Bedlam held 282 different
inmates, but it admitted 219 and discharged 20$.'' This transit camp of the mind, with its constant turnover, was entirely unlike the

any firm basis in reality to Foucault's vision of the 'age of confine-

ment.' Was there a major disjunction in Western treatment of

shameful, and that the best treatment is forcible isolation from

deviants in about 1650, based on a new principle that madness is

lifelong prison of the medieval leprosarium. Finally, Foucault's attempt to link the treatment of schoolchil-

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tlrcn, the poor, criminals, and tlic ins.inc under n sinKlc conccptii.il
umbrella, since all were subject to confinement, is both iinhistoric.il

and misleading. No serious sctioliir would doubt thnt the poor, in or oiit of workliouscs, have been sub,st;intinlly relieved of tlic
crushing burden of indi^cncc in the Inst two hundred vcnrs, or tli.u children, at lenst up to the it^rto.s, n-crc incrcnsinpty better cduc.itcd.

nnd thus better prcp.irctl to take their place in society nnd better able to improve their chances in life. Moreover, poor parents
willingly paid money to send their children to school, since they

It also undercuts the basis of the whole lihcral enterprise of the last two hundred ycnrs, which has done so much to diminish man's personal and legnl inhumanity to mnn. One has only to read how the medical profession treated Kinp George III when he went mad cnca.sin;.; his body in m.ichinery, chaining him to a stake, bc.itin;.; him, st.irvinp him. thrc-itcnins him, blistering and bleeding him,
giving him digitalis, tartar cmctic, and other noxious medicines to recoRniy.e that the shift to 'moral' treatment of the insane was a

knew it gave them moral precepts, behavior discipline, and IcarninR

skills that would come in very useful in later life. Whether criminals and the insane have either benefited or suffered much from incarccranon is an open question.

major amelioration of the human lot, regardless of its practical

efficacy in makins lons-tcrm cures, which admittedlv was not

The central challenge of the Pouc.iiilt model is to the humnnitnri.in

values nnd .icliievcmcnts n{ the ci^litcentli-ccntiiry I;nlightcnmcnt.

The acute sensitivity tn cruelty, ,ind tlic vaulting arnbitinn to cure socinl ills by the use of planning and science, were first m.itle

great. It is not enough to advance the valid argument that more humane trcntment ot the insane depended on the revolutionary notion that the loss of reason was neither irreparable nor a cause to treat a humnn bein;!; like nn animal, and that the cure depended on (renting the mind r.ither than the body. It is perfectly true that
theory determines treatment, but the wide extent of the humnnitarinn trcntl is still undeniable.

possible by the decline of religious faith in the late seventeenth and eighteenth centuries, which opened the way to a more secular yiew of human ills and their possible nmelioration. Sins against the Floly
Ghost and violations of God's law such as heresy now took a lower

Foucnult and his followers ar^uc that it was the doctors who
were behind the great confinement of the insane, whereas in fact a

priority than acts that were harmful to sentient creatures. It has to

be admitted, however, that this desacralixing of traditional morality

also opened the way to the use of cruelty as a value-free means to secular ends - political for Machinvclli, sexual for Sade, racial for Hitler.^ Despite these possibilities, the Enlightenment was <i force that in

better case can be mndc that they were merely responding to social demand. Society was willing and anxious to pay for incarceration. The private mndhouses that sprung up all over England in the eiphtcenth century were run by entrepreneurs who supplied an
expensive need of society. Large numbers of well-to-do families were now willinp to pay to have their ment.illy defective children,

or hysterical or merely rcdundnnt wives, or senile parents taken

care of by someone else, out of sipht nnd out of mind. There w.is

Western Europe resulted in the substitution of imprisonment for torture, mutilation, or death as the main punishment of poor criminnl.s; tlie .ibolition of the slave tr.idc; the reform of condition.s in

push more than pull at work in the creation of the English private madhou.ses of the early eiphteenth century, and even more in the buildins of the liupc public asylums of the early nineteenth centurv.
Moreover, nil the children in schnol, ns well as the in.sanc in

the prisons, which reduced opportunities for hideous cruelty (as well as those for en.sy-poin;; tolerance of irrcpularities); the reduction and final abolition of the appnllinp flopgin^s (up to 1,000

m.idhoii'ics, were paid for by their rcl.itive.s or by the parish under the conviction, often fulfilled, thnt the experience would do them
good. As for the helpless poor, some of whom were confined in
workhouses, it is hard for nnvone who has read about their

In.shcs) which were common in the nrmccl forces; and the introductinn of moral therapeutic mcthud.'; of treatment of the insane.

TIic hostility to cruelty in the late ciglirecnth century covered so

wide a front, ranging from the treatment of soldiers to that of criminals, chimncy-swcep boys, bnxers, women mine workers, and

conditions in ciphtccnth-ccntury London or in France to believe that their lot has not improved since the age of confinement. This leaves only the poor criminals, and even they, if asked, would

baited bears, that denial nt its reality flies in the face of the evidence.

probably choose prison rather than the altcmative penalitics of

severe flopging, multil.ition, or execution.

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Foucault thus provides us wirh a dark vision nt modern societv

di.sc.i.sc, such as epilcpsy or hysteria. The Catholics chose the devil

which accords with only some of the historical facts.'1' Abstract nnd
metaphoric in expression, unconcerned with historical detail of time nnd plnce or with ri{;ot-ous document.ition, Professor

theory, and threw him out by the use of cxorcism, a magical process using the Euch.irist .ind other sacred objects and words to put the
devil to flipht; nnd the trentmcnt often worked. Protestants, who

Foucault's work has had an enormous and disturbinp infliienrc

upon traditional views crf recent Western history. By challen^ini; the conventional wisdom of the Whi^ interpret.ition, he has forced the historians to turn to a careful investigation of the f.ict.s. He deserves full credit for drawing attention to the growth of confincment of a variety of dcvinnts over the past two hundred years, for

believed that miracles li.id ceased with the apostles, had no such
remedies to offer to the possessed.

Medical pr.ictitioncr.s hastened to fill the void, for example in 1589 when the Throckmorton children were diagnosed by Dr
Barrow of Cambridpe University as bewitched, on the basis merely of a urine specimen. The children caused the executions of three
members of a family as witches, before 'these abominable little

casting doubt on the motives of professionals, and for focusing

attention upon the history of the treatment of insanity. It is he who has set the agenda for the last fifteen years of research.

girls,' as Dr Walker rightly calls them, decided that the game had
gone on Ion;; enough. Belief in possession was closely linked to

belief in witchcraft. In 1600 a number of English writers were There nre several possible ways of tackling the history of madness. One is by in.stitutionnl histories of the places of confinement, the private madhouscs and their successors the public asylums. Another
casting serious doubts upon possession as anything more than a mixture of melancholy and ambition for notoriety by young girls, working upon n popular belief in the stereotype of the witch as 'an old wenther-bcaten crone, having her chin and her knees meeting for age . . . i;oini; mumbling about streets, one that hath forgotten her pater noster and hath yet a shrewd tongue in her head.' But denial of the reality of possession led to denial of the reality

is by a study of ideas about mndness, particular types of madness, and how to treat them Jn order to display changes in the underlying
conceptualization of the mind/body problem, and chnnsinp role.'; of revealed religion, magic, and scientific medicine. A third is bv

seeking out the rare records of the host of unqualified practitioners,

to see how they regarded patients, how their patients repardcd

of the devil, and denial of the reality of the devil was an encouragement to atheism, for 'if nn devils no God.' Dr Walker suggests
that women were particularly liable to possession since it was the

them, who those patients were, and whnt treatments they were
prescribed.

only wny they could draw attention to themselves, and get the chance to preach to a lari^e audience. But in the long run the
rejection of miracles by Protestants lcd to skepticism about possession; skepticism about possession led to skepticism nbout devils; skepticism -ibout devils lcd to skepticism about witches; skepticism .ibout witches lcd to n more rational religion; and n more rational retipion opened the way to the development of early modern science. As John Aubrey remarked at the time, 'Printing and gunpowder have frightened away the fairies.'

One type of m.idncss, so-c.illcd 'pos.ses.sion' in the sixteenth ,ind early seventeenth centuries, h.is been mncfc the subject of .1 brilli.int

little book by D. P. Walker, the implic.ition.s of which are vcrv far-reaching.7 Possession was a species of mndness which could

only be dealt with by magical means, since it wn.s thought to be

the involuntary occupation of an individual by a devil. The marks hidden secrets, supernatural strength, and horror nt the use of sacred objects or words. Many of the possessed denounced their
neighbors as witches, which lcd to the denth of m.inv innocent

ot possession were speech in an unknown language, knowledge of

Another way to approach the history of madness is to investigate

people. If fraud was not involved, the only possible explanations for such symptoms were possession by the devil, or some physical

the vast underworld of unlicensed practitioners - wise men or

women, magicians, astrologers, amateur clergy, and downright quacks. Taken all together, it is clear that in the towns the total

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niimhcr of these prnctinoner.s pt'r capita was very \nry,c intk-i.'d, even by modern standnnl.s, perhaps as hifih as (ine per 250 to 400 inhabit.ints. The qunntity w,rs rlicrcforc ample, whntcvcr may be s.iicl .ihout the qunlity of the treatments pre.scribfd. In sixtccnthnnd scventccnth-ccntiiry I-'.ni;lnnd, even country people hiid someone to turn to - more dficn than n<it an iinliccnsctl pr.ictitioncr - within five miles.< 'I'hc problem for the historian is to find out about these prnctitinncrs and their p.iticnts, since the former did not normnlly keep records, and if they did they tended
to be dc.strovcd.

scientific theory, and the new Latitudinarian and r.itionalist

rclisiou.s atmosphere of the post-Restorntion period. The Reverend

Richard Napicr would not have fitted easily into the world of
Samuel Pepys and Kinp Charles II. He was a product of a specific

period of history: one of home care rather than confinement, of

amateurs rather th.-in professionals, and of therapeutic eclecticism rather than pscudo-scicntific medicine. He is important both as an cxcmpl.ir of the intellectual climate of the early seventeenth century and also as a c.-ircful notc-^taker who opens a window for us on a
hitherto unknown world, that of the humble, or not so humble,

patients themselves, nf whom this book deals only with those who Every now nnd tlicn, hnwcver. an inquiring schotnr stiimblcs ncross some unknown and rcvcnlinp cache of documents, and if he h.is

were psychologically disturbed rather than physically ill. Napier's

clients were drawn from those classes able to afford to pay his modest fees of six to ciphteen pence per consultation - that is, the

the imsinatinn to see the possibilitic.s (and the stnminn to c.irrv ni.it tlic enterprise) he stakes out his cliiim anti starts c1i^"'>K- Aboiit ten years ago. Professor Mich;icl MacDonald found one such ^old
mine - a series of cictnilcd cnsL'l-xinks of Cio,ooo con.sultntion.s over

top three-quarters of the population, excluding the very poor.

Half of them came from within ten miles, and almost all from

BuckitiRhnmsliirc' or neiphborinj; counties. They .ire thus a pood

n pcriotl of thirty-.sevcn ycnr.s frnm 1597 to 1634, kept by rlic most

popular practitioner of both physical and psychiatric hcalinp, we know of in early scvcntccntli-century England. \Vh,u makes this
stiidy .so impot-tiint is \wt onlv the sc.ilc nnd dcr.iil of the dnciimcnt-

sample of a rural popul-ition not too far from London.

The first surprise is how relntivcly few of Napier's patients were psychologically sick. Today it is reckoned that about one-third of nil patients who consult some kind of mcdicnl practitioner arc either overtly psychologically sick or suffer from some mental disorder that finds expression in physical symptoms. Only $ percent of Napicr's patients, however, have been classified by MacDonaId as suffering from mental as distinct from bodily illness. This suggests that the frequency of psychological illness in pre-modcrn societies may have been relatively low compared with those of the contcmporary, modernised world. Nearly two-thirds of the psycholopically disturbed patients were women. This was explained by medical theory, which recogni/.ed that physical disorders connected
with the uterus, which they mvsteriou.slv called the '.suffocation of

ation but also the intellectually .imbipuou.s position of the prnctitioncr himself, the Reverend Richard Napicr.''
Nnpier was teetering unstcnctity on the cdscs between mnsic,

nstmloRV, alchemy, rflipion, nnd the cnntcmpnrnry ineclic.il plinrm;u'opcin, and was i.inccrrain in his own mind where truth nncl

efficacy lay. He was n lc.irnctl Anglic.in tlicoloRinn - a Master of Arts of the University of Oxford, nncl the parson of n rur;il pnri.sh in Buckinghamshire. F-Ic wns an nstrologcr who told lioroscopes. He was an alchcmist, a mnthcmatician, and a conjurer ot spirits,
u.sin^ an archangcl as a medium. He was one of the Inst Renaiss.incc magi, an expert in ,1 whole series of now wholly discredited but at

the mother,' caused psychological symptoms.

Mclancholia was the great affliction of the elite and intellectuals

the time highly sophisticated and respected intcllcctunl sy.itcnis,

Galcnic, Rosicnicinn, alchcmicnl, Hermctic, cnbalistic, Ncoplntonist, and also Christian. To some contcmpomric.s he was suspect as a 'nccromanccr,' a 'conjurer,' whose activities were cliallcnRccl by the 'piss-prophcts,' the profcssionnl doctors with their urine
specimens.

in the early seventeenth century, but Napier's casebooks shows

that it was equally common lower down the social scale. Many

women were plunged into depression by their oppressed lot as females in a patriarchal society, at the mercy of their parents or
husbands. One seventh of both sexes were disturbed by the threat of economic disaster, especially ruin and imprisonment for debt, which was an cvcr-pre.scnt menace to the small shopkeeper and

His eclectic notion of c.iusation was sonn to he tli.ssolved in the li^ht of tlic new B.icnninn scientific mcthntl, the new Ncwtnni.iii

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trading classes, in an age in which interest rates were hiph, price

fluctuations and environmental hazards great, and insurance
nonexistent.

Those who believed themselves bewitched by a neighbor were twice the number of those disturbed by frustrated love or marital mistreatment. Indeed, a third of all Napier's mental patients

Napier's records shed a fitful light on problems of family history

in the early modern period. A number of the mentally cli.sturbcd

were troubled bv the usual misfortunes of mankind, fenr nnd jc.il-

thought they were bewitched, a statistic which throws a vivid light upon the degree of bitterness and malevolence prevalent in an early modern village. Professor MacDonald is one of those who believe
that 'hatred, fear and violence were endemic in rural England before the Industrial Revolution' - a view with which I wholly concur. It

ousy, marital disputes, disappointment in love or m.irrinsc. Bereavement, however, did not loom larg; as a cause of nnsuish, presumably because it was so common. It was the cumulation of misfortunes that was too much. Take, for example, William Sroe, about whom Napier's note runs: "Much grief from time to time. Had a wife long sick who died after much physic. I-ost much cattle which died. H.id the pl.i^uf m liis house: two children dictl [.ind he] himself had it. ... Never well since.' The death of children disturbed a number of female patients, but it is noticeable that all the recorded cases arc of children over the age of four. Infants died so frequently that few parents were seriously disturbed by their loss, but young children at their most bewitchinp .igc had a better expectation of life, and developed strong bonds of mntcrnnl affection. Napier thought it a si^n of mental abnormality {f a woman 'careth not for her children. Can tnke no joy of her children.' But then she was so depressed that she was 'tempted to hanp herself.'
Frustrated love was a not uncommon cause of mental strain,

was a world of suspicion, intrigue, petty jealousy, sudden brawls,

and vindictive revenges for assumed slights or injuries. When it comes to analyzing the recorded symptoms of mental disease, vast chasms of incomprchcn.sion begin to open up between ourselves and the inhabitants of the seventeenth century. Robert Burton, with his scholar's compendium of madness in The Anatomy of Melancholy, and Richard Napier with his practitioner's notes of actual cases, are equally difficult to decode. Napier recorded his clients mostly as 'troubled in mind,' 'melancholy,' 'mopish,' 'lipht-headcd,' in that order, running down through 'senseless,' 'gricvinfi,' 'weepinp,' 'frantic,' 'distracted,' 'furious,' to 'solitary,' 'suspicious,' or 'wandcrinR.'

It can he seen, however, that Napicr's universe of the mad

contnincd two basic types. There were those with uncontrollable violent energy or mental incoherence, who might be a danger to others or be incapable of caring for themselves. And there were those who suffered from physical torpor and emotional delusions and disorder - those he characterized as 'melancholy' or 'mopish.' Only a tiny handful of his patients were defined by him as 'mad' in the sense that they lacked nil sense of the links between personal behavior and the norms of society. It was these, and these alone, whom the seventeenth century locked up, chained, and physically punished to tn' to bring them to their senses. Thus only twenty of the 2,039 mental patients who visited Napier had been either chained or beaten. It was persons like those who composed the twenty or thirty in Bedlam in 1700 - who were visited by some 96,000 tourists a year. To contemporaries, madmen were men reduced to the level of animal.s, since they had lost the power of
reason and thus their soul.

even if few rejected lovers went as far as Thomas May: 'Grief taken for a wench he loves. He sayeth if he may not have her, he will hang himself.' A significant number of the lower middle clnssc.s

certainly fell in love in the early seventeenth century. But the

problem left unsolved by these case studies is whether tlicy represent a social norm of courtship and marriage for love, or are merely a small minority of eccentrics who were bucking the system of arranged marriage for money. Did they themselves believe that
to be lovesick was a form of madness? It is noticeable thnt about

a sixth of those distressed by courtship or love were frustrated in their wishes by the adults, such as a young man who was prevented by his father from marrying his lover and 'fell distracted.' Did a minority of the young fall in love but the majority obedicntly
follow the advice of their elders? We still do not know. More wcrr

disturbed by cruel or drunken or diseased or otherwise unsatisfac-

tory husbands, but this may have had more to do with day-to-day
survival than with love itself.

Both the patients and their learned advisers like Napier held one thing in common with modern man. Both believed that there is no

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ripid distinction between niincf nnd hpdv, nncl that the two internet

upon cnch other. Thus a near contemporary o{ Napicr. n more

colorful and eccentric chncacter catletl Simon I-'orm.in, who nlso r.in

and n.itural philosophy. By now, Kichard Napier and all his works were n hopeless anachronism, bypassed in the rush to supposed
moctcrnitv. Dr Walker and Prdfcssor MacDonnld have rediscovered nn

a large consuItinR prflctice, di.igno.secl a wom.in in i (97 in the

fnltnwing terms: 'Much siibjcct to mcl.incholv and full ot
fancies. . . . She hath not her courses, and the men.stru.il blnod

important but lost piece of the intellectual and cultural history of

the West, one wliich offers a plausible explanation of the triumph

runneth in her hcnd. And she thinks the ticvil doth tempt licr to
do evil to herself.'13 Whether Forman himself believed in the devil

is not clear, but the huge number of Napier's patients who thought themselves bewitched is proof of how widespread was n mapical view of causation among the populntion nt larpe, N.ipicr'.s eclectic treatment, which included mnsicnl amulct.s, Chrisrinn prnycr.s,
astrological horoscopes, and Gnlcnic medicines, shows his own
iincertnintv about where the trutli lay.

of professionalism in the late seventeenth and eighteenth centuries, ,-incl the modest spread of private mndhouses. These two studies fit these changes into the changini; cultural patterns of an increasingly secular and optimistic ape. This makes much more .'.ense than
attributinp them to nn evil conspiracy of the early modern burc.iu-

cratic state nnd professional elites to enslave the multitude. Amon^ the poor, however, the old system of semimagical beliefs persisted. Bacon himself had expressed skepticism about the
efficacy of medicine, 'a science which hath been more professed than l.ibourcd, ,int1 more Inbourccl thnn ndvanced,' a point of view

In his concluding chapter. Professor MncDon.ild peers bcynncl into the late seventeenth and eishtccnth centuries, the sy,c of rlHmonopoly of trc-itmcnt by the mcciicnl profession, and of increasins care in private madhou.sc.s. He sees two intcrlockinp trends nt work. The first, stimulated by the religious excesses of the Englisli rcvolution, was a rejection by the elite of retisious cnthusia.snr. anti

which opened the way to innovations in anatomy and chemistry. The poor, however, remained wholly skeptical, and a popular
almanac for the year 1688 predicted that physicians 'would all be

by extension of all rcligio-magical explanations of how the world

worked. The theory that the devil wns at work in the possessed or
in witches was no longer regarded as credible. After the experience of the Civil War, irrational systems of belief were seen ns tlircnrs to the established social order, which the ruling classes were dctermined would never again be subject to such ratlicnl chnllcnRC. a form of madness, while dcmonic possession was treated ns mere delusion or hypocrisy." Suicide ceased to be regarded n.s a sin

busy killing sick people.' As a result of this conservatism, there emerged in the late seventeenth century a major dichotomy between elite and popular culture with respect to the efficacy of doctors and
the treatment of the insane.

Nor were the poor altogether wrong in their rejection of the new order of things. Private madliousc.s were indeed often a public
scandal, and it was not until 1774 that Parliament passed the "Madhou.sc Act' to set up a system nf licensing and inspection. Foucault is almost certainly right to believe that confinement in the

ReIiRious zeal was now equated with 'enthusiasm,' and rcpardcd as

eighteenth century was a retrogressive step by which more and

more of the mentally ill were subjected to the treatment hitherto
restricted to the cl.inperous lunatics. Moreover it was now easy to

apainst the Holy Ghost, instigated by the Devil, and to be punished by burial in unconsecratecl Rround .ind seip.urc of property.
Jurymen now declared that .suicides were non compos mcnti.s 1: 'Reason' was now king, and since medicine was allegedly scientific, it was the medical profession that naturally took charge of the insane, and confined the worst cases, .iccorclinp to the prcscribctl
rules of their profession.

abuse the services of private madliouses out of personal spite, and nothing was more common in the eighteenth century in a marital

quarrel than for a husband to threaten to lock his wife up in a

mndhouse.

On the other hand, the prcat humanitarian movement of the late

Uespite the total lack of any evidence of the practical effectiveness of curing the insane by purges, bleedinp, cmetics, and chains, professional medical theory fitted neatly into post-Rcsror.ition elite culture, compounded n.s it was of rational religion, ncoclassicism,

eighteenth century appeared to change all that; it provided the basis on which the st.itc built larger nnd more elaborate asylums. The
'moral' methods of leniency and kindlv treatment were first intro-

duced by William Tuke at the York Retreat in the late eighteenth

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century, and as a result the Victorians were convinced that the bad

but another to put in its place an equally simplistic pessimism that

seems unable to distinguish antibiotics or insulin from charms,

old days of medical mistreatmeht of the insane in madhouscs were over. They reflected comptacently on how in the eighteenth century 'cocrsion for the outward man and rabid physicking the inward man were specifics for lu.nacy. Chains, straw, filthy solitude, darkness and starvation . . .; nothing was too wildly extravagant,

prayers, or whips. The strength of the work of Walker and MacDonald is the sophistication of their interpretations and the
close attention they pay to the sources. In their hands insanity becomes a window through which to observe fundamental changes
in the intellectual and social life of the West, as rationality slowly

nothing too mon.strously cruel, to be prescribed by mad-doctors.' Nonmedical practitioners now tried to work on the mind rather than on the body, and by gentle rather than forceful methods which was a direct challenge to the monopoly of treatment now claimed by the medical profession. The lows classicus of this great reform is the picture of Pinel striking the chains from the lunatics
at Bicctre in the middle of the Terror in Paris. Lunacy was now

took the place of faith, magic, and superstition. Whether this was a change for the better or the worse is, unfortunately, still very
much a subject of dispute.
PART II

regarded as a curable disorder, given the right physical conditions

and the right psychological treatment. Unfortunately, however,

An Exchange with Michel Foucault

this optimism was unjustified, and the Victoriiin asylums slid impcrceptibly back into holding-pens for persons patently incurable. Attention of the well-meaning was therefore focused on the humane
treatment of the inmates, rather than upon their cure. the sick mind, an endeavor that has had only very limited sticcess.
Today, we are back to where we were in the seventeenth and

There followed the rise of psychiatry as a profession to deal with

1 Letter of Michel Foucault

eighteenth centuries, restoring the mind by treating the body with chemicals instead of purges and emetics, and electric shocks instcncl
of whips and chains. Th.-inks to drup; therapy we arc also emptyinfi the asylums, and releasing their inmates once more into the streets, where they had been up to the eighteenth century, before the ^rc.il confinement began. Some aspects of tlie nineteenth-century phn.se of these dcvclnpmcnts in the treatment of madness arc illustrated in a useful series

(1) You ascribe to me the thesis that, as from 1650, a new principle emerged according to which 'madness is shameful' and "the best treatment is forcible isolation from society under management by professionally trained doctors.' This view is precisely the opposite
of that which I have set forth as the main argument of my book

of essays about particular institutions and personalities edited by

Professor Scull.13 Over the entire collection, however, looms the

and enlarged upon throuph the full five chapters of the first part. Namely, that the procedures and institutions of confinement evolved throughout the whole of the sixteenth and seventeenth centuries, and did not begin in 1650; that they were essentially extramedical; that the results aimed at were only partially thera-

brooding figure of Professor Foucault, whose creative, if pessimistic, imagination still dominates the field. One very serious result of the current mood of dcnipration of doctors and scientists is n downplaying of the crucial distinction between truth and falsehood. Some treatments of the insane used today seem to work; almost all used in the seventeenth and eighteenth centuries did not. It is one thing to overthrow the simplistic Whig interpretation of history

peutic. The dates, conditions and regulations of these nonmedical confinements are analyzed on pages 56-123 of my book; the limited space allotted to medical practice is analyzed on pages 124-77. Why do you not take into account these 120 pages which utterly refute
the thesis you credit me with? And why do you ascribe to me an untenable thesis, never, to my knowledge, maintained by anyone and certainty not by me?

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(2) You crcilit me witli (lie i<k'.i th.tt this was merely tlic rcsiilt of 'n conspiracy of protcssionals to sei/c- power for tlicm.st^'cs to lock people up.' This is, onrc ns-'lln' tl'lc cx''lct "ppu''itc of wli.-it I. have said.. To bcy,m with, 1 never had recourse to the notion <?t 'conspiracy' to .inatyy.e this liistoricnl phenomenon, or any other.
Moreover - and thi!> forms tlic subject matter nf mv book - I h.ivc

hidden away and at the same time exposed; both attitudes are borne
out tiv mv references.

A little more attention would have prevented you both from over-hnstily levelinp at me an ill-founded reproach, and from

supporting the said reproach with such a wondrous strange chain

of reasoning. (5) You argue that there are 'enormous differences in the deprcc and organization of incarcerntion from country to country,' England speciali/.in^ in private institutions and France in stntesupported ones. Now, on pages 67-74 and 483-96, I insist on the pronounced differences between a country like France and a country like Englrtnd where religious organization, legislation, institutions and attitudes provide much more scope for private initiative; I point out, in particular, the long tradition with which

attempted to show the length, tlic diversity .ind the complexity of the processes which finnlly, after a century and n hnlf or more, lcd to the scttins up of a spcciali/.cd psychi.ury .ind of ,1 boily (if
alicnists who were able to claim the exercise of medical niithtiritv within the framework of (lie institutions of confinement. WIint I

wrote is therefore not the description of a conspiracy; I never set

down 1650 as the date of a medicalization; and I never considcrd

doctors to be the sole agents of such a medic.ili/.ition. Yoii nrc entirely mistaken on nil three points. Why? (3) You raise the objection that there is evidence of the contincmcnt of mndmen during the Middle Ages, as if I did not know or mention such facts. Now, I refer precisely to such accounts of

Tukc is in keeping and which evolved throughout the eighteenth

century. Nevertheless, you arc wronp in thinking that everythins
in France was state-controlled.

(6) When you argue that the incarceration of the indipcnts

occurred mainly in tlic seventeenth and eighteenth centuries, and
thnt of the insane in the nineteenth centurv - it is true that I know

confinement as can be found and I point out that there existed, in this respect, a very o\d tradition that assumed, in j^tcr yc.irs,
another dimension; I mention n certain tiumlu'r of cdnmptfs 011 papcs 20-1 and 125-7;I also point out (pp. 161-2) tli;it, throughout the Middle Ages, madmen were sometimes lockctl up and displiiyctf like animals. Assuming that you linvc read my book, could you have copied wliat I said the better to reproach me with not hnvins
said it? Or should I believe that vou hnve not read it?

not wh.it to answer nny more than I can guess to which passage of my book you refer, since it is entirely concerned with the slow evolution from one form of confinement, intended mainly for the poor, into a confinement involvinp medical treatment. You content yourself with repeating my general thesis while twisting it into an
objection.

(4) Yet another objection on your part: madmen were not 'isolated' since tourists went to see them where they were kept in
ch.iins. Two comments:

(7) Contrary to what you claim, I never compared "the treatment of the mad' to that of lcpers. I pointed out that a certain number of disused leprosaria were employed for other purposes and in particular [for] a confinement which was, in the seventeenth and ciphecnth centuries, only very partially therapeutic.

(a) Uo you really believe that locking people up and making -in exhibition of them proves that they are not submitted to scpregation? Just tell me, fettered and howling in a yard or writhing

(8) You reproach me with having placed under the same 'conceptual umbrella' the treatment of schoolchildren, the poor, criminals
and the insane. And you emphasize the fact that the condition of the indigents has greatly improved in the last two hundred years and that children 'at least up to the 19605' are increasingly better
educated. Now,

behind bars, subject to the jibcs of pnwking onlookcr.s, you woultl

not feel slightly isolated?

(b) Now, it so happens that I have mentioned, with approprinte

references for both France and F.:ngland. these visits to madmen

(a) I never denied what you put forward in these last two propositions; I never even broached the subject.

made a show of in this way (pp. T6i-3). I consider these f.icts n.s
an aspect of the complex .ittitiide toward madmen: they were

(b) I did not, in my book on insanity, ever touch upon the

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question of schoolchildren and their education. Can you quote the

passage where I am supposed to have done so?

(2) I fear you have taken a considerable risk. Think of those who
h.ivc read mv book; think of those who will read it and want to

(c) Neither is the presence of criminals (often enjoyinp a special status) alongside the poor and the insane in the same places of isolation pure invention on my part. It is a fact borne out by documents I quote,, more particularly on pages 56-123 and p.ipes
414-21. Are you in a position to deny this fact and to back vour denial with convincing documents?

collate it with your review of it. Is it of no importance to you that people may believe you to be 'unconcerned with historical detail of time and place, or with risorous documentation'? (3) Don't you agree that the probity essential to any scientific work should rule out such procedures? Don't you agree that only by respecting the work and the thought of an author can one

My problem was to understand the logic of n practice n-hich could concern madmen, criminals and the poor. But which in
no way concerned children, or the nineteenth and the twentieth
centuries, as you would have the render believe.

prevent criticism from falling prey to the bad habits of hurried

journalism?

(4) I first published my book more than twenty years ago. It

was, at the time, a little '.solitary' in a field the historians had,

(9) Finally, harking bnck once more to this thesis I never uphrld (according to which doctors were 'behind the great confinement of the insane'), you argue that society was anxious to 'pay for incarceration' and that there was, in this respect, an import.int social demand on the part of the family circle and the cntour.ise;
in France, the lettre de cachet, which was one of the me-ins of administrative incarceration, was more often than not dcmnndcd

perhaps, not fully explored. It is of course necessary that it should

be revised, refined, corrected, enlarged upon. Fortunately, since

then, the problem has developed, as you justly point out, into a topical question. However, doesn't the fact that, twenty years later, it gives rise to so many obvious adultcrations on the part of
someone who should have stayed cool-headed signify that the prob-

lems it has attempted to deal with are .still charged with passion?
All the more reason then for one to be, in discussion, as attentive

by the families, and confinement, even at Bicctrc, had to be paid for, in many cases. Besides you must not imapine that tt was onlv the 'well-to-do families' you mention who made such requests ,iiul were willing to pay for tlie subsequent upkeep. All in alt: nine major errors, spread out over two small columns and a bit; th.'it's a lot. I <im not in the habit of replying to criticisms as I consider the reader quite capable of putting blatant adultrrations right all by himself. However, the regard in which you are held prompts me to submit to you these few answers, which could be far more detailed. Indeed, they provide me with nn oppnrniniry to ask you a few questions. (1) The 'fidelity' you show to my book surprises me. You could
have quoted from sources other than those I refer to, mentioned

nnd as scrupulous as possible. Even when madness is restricted to ,1 subject mutter, it has somcthinR of a hlinding effect on the mind. It is for this reason I suggest we resume, amicably and in alt serenity, the debate on these problems, in as agreeable a manner

as possible t0 both sides. But first, I would appreciate a par.igraphby-parngraph coll.ition of what you have written about my book
with n'h.it I have actually written. The reader is entitled to know where the truth lies.

Do let us try, together, to provide the means to this end.

Michel Foucault
Paris, France

different facts, opened new perspectives. You have done no such thing. Out of the nine reproaches you level at me, four (numbers 3, 4, 5, and 6) consist in repeating what I said while pretending I never said it; three others (1, 2, and 8) consist in turning round, word for word, what I said and ascribinp to me the subsequent thesis which has become untenable. As for the ninth reproach. it combines, rhetorically, the two methods used throughout the
development.

2 Reply of Lawrence Stone I am sorrv thar Professor Fnucault is disturbed by my criticism of his ideas. Today he enjoys nn almost unparalleled position of intellectual clomin.incc over the interpretation of many key aspects
of the evolution of Western civilization since the seventeenth

centurv. We are none of us infallible, and Professor Foucault would surely concede that someone in his well-deserved position of pre-

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eminence must expect his itfe.is to be subjected to reasoned and

version made by the author, only onc-third of the original 613

pages, which is possibly the cause of some confusion among English readers, and certainly for the sense that many of the ideas are poorly documented.
On reflection, I think I did Professor Foucault an injustice on two

temperate critical scrutiny. The historian faces several problems in dcnlinp with the writings of Professor Foucault. One is that he is
not at alt easy to understand, bccau.sc of what an unkind critic has

called 'his obscure, nrro^nnt, scnsntion.ilist, nnd op.ique form of

discourse, whicli bv his own admission is n "labyrinth into which

I can venture ... in which I can lose myself." '{i A second problem is caused by the tenuous connection of stnic-

turalism to history. Even if they can be understood, the systematic structures of discourse that are alleged to underlie major intellectual
changes cannot always be made to conform to the intractable rcalities of historical evolution as revealed in the records: the facts

don't always support the theory. Thus Foucault may be superbly insightful in propounding certain brilliant conccptualization.s nboiit the eighteenth century, such as 'the great confinement,' or "the
desire to know' about sex, or 'the birth of the clinic,' or the transformation of sr"mmnr. But he may also have made mistakes,

counts. First, I did not make sufficiently clear what everyone knows, namely that his true originality lies in his structuralist mode of explanation, concerned not with such mundane matters as how men pursue self-interest, or the way in which professional and bureaucratic groups develop independent interests of their own, or even what it is they think about their work. He is concerned with structural ways of how they think, their modes of discourse, which according to him determine everything else.
The second way in which I did Professor Foucault an injustice

perhaps not fatal ones, in his chronology, typology, and causal explanations, and may be lacking hard data needed to prove his
hypotheses.

was that I failed to make it clear that I was dealing with a large international body of thought covering many disciplines, namely Foucauttism. Now it is probable that not all the ramifications of

Foucaultism meet with the approval of the master himself, although he has so far done nothing, so far as I know, to repudiate them.
It is his followers who have taken up his denial of humanitarian or Enlightenment motives behind the evolution of the moral care of the mad, or a medical approach to disease, to put forward a more sociological conspiracy theory about psychiatrists and doctors; and it is they who have taken up his concept of the great confinement in prisons, asylums, and hospitals, and added schools to the list. One can, I think, debate the extent to which an original thinker is responsible for the ramifications, or extensions, or perversions, of his work by others. Can Marx be held responsible for Marxism? Can Foucault'.s pessimistic evaluation of lunatic asylums be held to have been a factor in the recent discharpe of thousands of helpless psychiatric patients onto the pitilcss streets of New York? Dr Gerald Weissmann of the New York University School of Medicine

For example, on the basis of a small number of quotaticms, he has postulated a major shift in consciousness in the eighteenth
century, from believing that it was cruel to criminals to confine them with madmen to believing that. it was cruel to madmen to confine them with criminals. To the historian, such a shift of

mentalite would require a lot more proof than a bare handful of quotations and the fact that the two groups were indeed separated.1'' A third problem is that Foucault's generalixations lend themselves so easily to adaptation and extension, and perhaps distortion, by others. Thus his remarks about 'the Doctor as an alienatinR fipure' gave support and cncoumRcmcnt to others, like R. D. Laing in Britain and Thomas Sza.sz in America, to press their belief that institutional psychiatry is largely a conspiracy for power and prestige by a professional group with very dubious scientific crcden-

believes that these tragic cases are indeed a remote by-product of

Foucault's negative evaluation of the philanthropic dream of Pinel, coupled with the fashionable claims by the English revisionist psychiatrist R. D. Laing that schizophrenia is not a disease.17 This leads directly to the central criticism I made of Professor Foucault's ideas, but one to which he has not responded. Although

tials.16 Foucault certainly never sank to such mundane sociological explanations, but his writings lcd logically to it. Similarly tie has never mentioned schoolchildren among the confined; but a host of American and English critics of the school as a repressive institution

have drawn that conclusion from his work. Lastly, the English version of Madness and Civilization is a translation of an abridged

he claims moral neutrality, in practice he denies any philanthropic

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motive to the i^reat reformers of mental treatment in the late ninetecnth century. In Madness and Civilization he denigrates Tukc,

standing and sensibility, and a causal linkage of it to the sexual

fantasies of domination, violation, and torture which obsessed the mind of Sade. As for the charitable investment of money by the

since 'the religious and mor.il atmosphere was imposed from

without, in such a way that madness was controlled, not cured' (p. 244) in a place 'where any manifestation of madness will be

rich in building hospitals for the poor, in Birth of the Clinic

Foucault ascribes this act to a self-inierested desire to obtain

linked to punishment' (p. 246). The key principles of Tuke arc

defined as "surveillance and judgment' (p. 251). Foucault firmly links the new reformed asylum to patriarchy and the bourgeois
family. Nor does Pine) fare any better at Foucault's hands: with him the

asylum becomes 'an instrument of moral uniformity and of social denunciation' (p. 259). Foucault describes it as one of 'the parndoxes of Pinel's "philanthropic" and "liberating" enterprise, this

subjects for human medical experimentation: 'what is benevolence towards the poor is transformed into knowledge that is applicable to the rich . . .' (p. 84). 'The doctor's gaze is a very small saving in the calculated exchanges of a liberal world* (p. 85). 'Like civilization, the hospital is an artificial locus in which the transplanted disease runs the risk of losing its essential identity' (p. 17). Small wonder that such language has lcd to a host of conspiracy theories about both the medical profession and the rise of the hospital.
The main objection to this 'dominance and control' model of

conversion of medicine into justice, of therapeutics into repression'

(p. 266). In consequence 'Madness will be punished in the asylum,

even if it is innocent outside it' (p. 269). He writes that 'our philanthropy recognizes the signs of benevolence towards sickness

where there is only a condemnation of idleness' (p. 46). This stress on control, repression, and punishment has bben combined by Foucault with emphasis on the growing pow^r of 'the
medical per.sonape . . .' (p. 269) 'whose powers borrowed from science only their disguise, or at most their justification' (p. 271). 'In the patient's eyes, the doctor becomes a th.-iumaturge . . .' (p. 275). 'The doctor, as an alienating figure, remains the key to

human relationships is that is is based on an obscure structuralist theory of discourse, which may or may not be well founded.It is a model so all-embracing as to be virtually meaningless. It can include anything from using forced labor in the Gulag Archipelago to teaching children to brush their teeth. Since man is a social
animal, and since all of social life involves some form of influence,

molding, direction, or compulsion, the reduction of all social relationships to issues of power renders it almost impossible to
make the fine intellectual, moral, and material distinctions necessary for any serious evaluation of change in history.

psychoanalysis' (p. 278). (Why alienating?) Foucault'.s final words

on the late eighteenth-century transformation of the treatment (if mentnl illness describe it ns "that pipantic mor.il imprisonment whicli we are in the hnbit of calling, doubtlc.ss by antiplir<isis, the lihcration of the insnne by Pincl and Tuke' (p. 278). Small wonder thnt the sociologists of profession.ili/.ation were stimiilated by him to look for an explanation in a struggle for turf and dominance hy doctors and psychiatrists.

For example, when does social control end and socialization be^in? One definition of the latter is 'a neutral concept concerned
with the objective needs of society to guide, restrain and control the members so that they generally observe accepted conventions

in thought and behaviour.''" No society has ever existed, or can

exist, without socialization. Moreover, the iron law of ollgarchy usually causes attempts at some degree or other of the imposition,

Exactly the same pessimistic evaluation has been applied by

Foucault to the concurrent evolution of clinical medicirte, which

if necessary by force, of the views of one group upon another. For historians, it is precisely these fine distinctions which make one society at one time different from another, but Foucault's blanket
structuralist affirmation of dominance and control severely limits

he summarizes in the following way: 'The abyss beneath illness,

any discussion of such refinements.

The second weakness of Foucault's model is that it totally

which was the illness itself, has emerged into the li^ht of lansiinRC the same light, no doubt, that illuminates the 120 Journecs dc Sodome, Juliettc, and the Desastres de Soya.'w Here again we find
a denial of the Enlightenment as an advance in hum^n undcr-

neglects the near-certainty of serious differences in beliefs and aims among the so-called controllers, as well as in the methods they use. Third; it ignores the gap between intentions and results. As often

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as not in history, the movers and shakers either fail in their objccrives, or the consequences turn out very differently from what they
expected, due partly to the perverse recalcitrancc of hiimnn n.iturc

1. (.-i) Madness ns shameful and so to be hidden: "the shameful promiscuity of madness' (Madness and Civilization, p. 22$);
' L'intcrncmcnt ciiche U dcraison ct trahit la honte qu'clle susdte'

among the controlled. Fourth, the moJcl reduces the actors in

history to two, the controllers and the controlled, ignoring the pluralism extant in all social systerfis, and the wide variety of influences of state, church, family, and peer groups, which nrc nt
work to mold men's minds.

Fifth, Foucnult'.s model .issumcs not only that .ill controllers seek power for the same end, but also that all tlic controlled, pivcn a free choice, would reject the mold imposed upon them. Tire idea, for example, that m.ihy of the poor might be positively anxious, of their own free will, to adopt bourgeois values and behavior for themselves and their children in order to get on in the world, or

(Folie, pp. 162-3). (b) Dating, 'the first moments of the "Confinement" . . ., that royal edict of April 27, 1656 thnt led to the creation of the Hopital General' {Madness and Civilization, pp. 46-7); 'From the creation of the Hopital General. . . until the end of the eighteenth century, the age of reason confined' (Madness and Civilization, p. 65); 'Le
classicismc a invcntc I'intcrncment'[Folie, p. 64);'. . . aussi soudain

the sick to be cured, or (lie mad to be treated and protected in

an asylum, is all but eliminated in Poucault's dominnncc model. Curiously enough, this is where liberal htstorian.s link up with Marxists, for the latter also dislike the control model since it appears to be incompatible with their cla.ss-conflict concept of society. .'3
The 'dominance and control' model, therefore, tends to ovcrsim-

plify the historic.il process, reduce society to two pol.irizKct groups, distort the psychology and values of the controllers, make unwarranted assumptions about their success in impo.sinp their will, underestimate the strength and independence of the culture of the supposedly controlled, and eliminate any possibility that the society, including the controlling elite, is ptur.ilistic and divided in
its objectives.-'1

fjne 1c grand Renfermement du XVII sieclc . . .' (Folie, p. 404). There is one page of random accounts of confinement of the poor in sixteenth-ccntury England, but little is drawn from it (Folie, p. 65). 2. 'A conspiracy of professionals.' This is admittedly not Professor Foucault's motive of change, but I have shown how his writings can lead, and have led, others to this conclusion. 3. Confinement of the mad in the Middle Ages: there is only one page (p. 10) about this in the English abridged edition, although more in the French. But I cannot see that even there it plays any part in Foucault's argument. I fail to understand how
one can be 'hidden away and at the same time exposed.' To my mind this is an unintelligible contradiction in terms.

I:inally, the I:oucault moilcl ignores the mornl dilcmm.i.s of society past and present. It is nt no help to us in tackling the rcnl
and difficult task of today, which is to decide which kinds of state

4. Differences between France and England: not discussed in the English edition, and only discussed in passing in the French on pp. 67-74? PP- 4^3-9^ concern Tuke and Pinel. I can find no serious discussion of the proliferation in cightecnth-ccntury Enplnncl of private madhou.ses, as opposed to French statcsupported ones (it is possible that 1 am defeated by the absence of
indexes).

intervention in personal life are justified by the social benefits accruing, and which ,irc not. Foucnult's model is useless in solvins the real dilemmas we face in dealing with such delicate moral issues

5. Exactly: but the evidence does not fully support the thesis, in
my opinion.

as the right of the individual to on-demand divorce, pornogr.iphy,

abortion, a minimum standard of living, equal access to finnncinlly
limitless health care and to a.*; manv finite resources - whether oil

or rhinocero.s horn - as he can pay for, and so on. After this statement of rctractions and peneral objections, let me now turn briefly to the points of detail raised by Professor
Foucault.

6. Treatment of lepers and madmen: In Madness and Civilization, "The lepcr was removed from the world, and from the community of the Church visible . . .' (p. 6). Then leprosy disappeared, and after an interval (filled in the French version [pp. 1618] by the victims of vcncral disease), the mad were placed in some of the old leprosaria. Here 'the formulas of exclusion would be
repeated, stranpcly similar two or three centuries later. Poor vagabonds, criminals, and "(lernnged minds" would take the part played

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by the leper' (p. 7). 'The asylum was substituted for the lazar
house. . . . The old rites of cxcommunication were revived, but in

the world of production and commerce' (p. 57).

Anxiety and asceticism

Michael Ignatieff
MICHELFOUCAULT

7. Correct: the school as a place of confinement is part of

Foucaultism, especially in America. Foucault has never, to my knowledge, mentioned schools as a part of the era of repression, but it is a typical, almost incvitnble extension of his ideas. 8. We both nprce tli.it people - rcl.itivcs or the parish - paid to have their mad relatives put away. In Enplnnd in the eighteenth century this was the normal method of incarceration, very different
from the Foucnult model in which the doctor was the decision
maker. The main motive was dcmonstrablv shame. In brief, I do not believe I have distorted Professor Pouc.iult's

money to the cause of the boat people, the Afghan tribesmen and the victims of General
Jaruzelski - but refused the embrace of any

Histrin de to SexuaBte

Tome 2, L'Usage de PIaisirs

285pp.207 0700599
Tome 3, Lc Soud dc soi

284pp. 2 07 027382 2
Paris: Gallimard. 85freach. These volumes appeared m the bookshops of Paris as their author lay dying in the clinic for nervous diseases at Salpfitrifere hospital. It is
said he was stUl able to read the first reviews:

political label, including the liberalism cun-ently fashionable in French intellectual circles. Foucault's celebrity was paradoxical. If French opinion polls of the 1980s consistently rated him the most important living French
intellectual, it was not because he was associated with any doctrine or idea bearing his name, but perhaps because he assumed the prophetic mantle of the French man of letters inherited from Sartre and Aron while retaining an ironic distance from its pretensions.

thoughts in any way, except the two which I have freely admitted,
and for which I apologize. He, however, has not directed himself to the central issue of my criticism, namely his pessimistic cvaluation of Enlightenment thought, and the institutions and

His intellectual influence is as paradoxical as

his fame. He left behind no consistent metho-

the Paris dailies devoted pages to him. One can

professions that grew out of it. It is his recurrent emphasis on

control, domination, and punishment as the only mediating qualities possible in personal and social relation.sl^ps that I find
one-sided.
copyright 1971-86, Nyrev Inc.

imagine his macabre amusement at reading his dological approach, no body of philosophical own obituary notices and at the tide of celebrianalysis, no theory which could properly be
ty enveloping him in death. Foucault's celebrity is something of a puzzle. He himself did not court it. He was scathing about the imprisoning and self-deluding role of prophet accorded French intellectuals by their public. While he sometimes succumbed to the temptations of that role - notably in his Ulcalled his own. Those who, in the wake of his

death, called him the most important philosopher since Heidegger were surrendering their judgment to the erigendes of funereal piety. Yet scarcely any philosopher working on
the history of philosophy or historian working

Foucault's reply and Stone's riposte the author

'Madness', New York Review of Books, 16 December 1983.

considered welcome for Ayatollah Khomeini's

Islamic despotism - he sought in his long silent

on the history of institutions, social science or sexuality can avoid confronting the challenge
of Foucault's books.

Poucault's reply and Stone's riposte, The Past and Present Revisited, London, Routledge 1987, pp. 268-294.

hours at the Bibliotheque Nationale to slip

away from his public persona as a master of
intellectual fireworks.

Looking back on his work now, one begins

to realize how much of its power and influence

Having devoted his intellectual career to studying how systems of ideas become systems of power, Foucault had the consistency and self-awareness to avoid making a system of power out of his own ideas. He had many

depended on negation. Against the philosophers he insisted, with Nietzsche as his inspiration, on the radical relativity of philosophical truth. In place of a philosophy of
reason, he wanted to write a history of truth, a

interiocutors - they all testify to his intellectual

generosity, scrupulous self-doubt and terrifying sense of humour - but he left behind no disciples. At his death, there were no Foucaultians as there are Lacanians and once were

genealogy of the scientific discourses of the modem age which produce their own account
of what is true about sex, society and the self.

Against the historians, he insisted on the radical discontinuities in the languages in which past and present speak to one another. In the idea

Althusserians. Although he held a prestigious chair at the Collfege de France, he remained a solitary outsider in French intellectual life. He

of an "epistemic break", he sought to highlight the geological fault-lines beneath the traditions
of ideas which historians had taken as unbroken terrain.

lent his prestige to many political groups - he

handed out tracts himself beneath the walls of

prisons, spoke in critical support of feminist

and gay causes, signed appeals and donated

His historical work lacked a theory of historical change: why such breaks in the languages of reason, madness, self-consdousness and so-